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Injection Practices in Romania Progress and Challenges

Published online by Cambridge University Press:  02 January 2015

Catherine Dentinger ,
Lili Pasat ,
Mircea Popa ,
Yvan J. F. Hutin  and
Eric E. Mast
Catherine Dentinger
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Lili Pasat
Affiliation:
Vâlcea District Health Department, Vâlcea, Romania
Mircea Popa
Affiliation:
Ministry of Health, Bucharest, Romania
Yvan J. F. Hutin
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Eric E. Mast*
Affiliation:
Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Viral Hepatitis, MS G37, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333
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Abstract

Objective:

To identify breaks in infection control practices that might put Romanians at risk for transmission of hepatitis B virus (HBV) from injections.

Methods:

A standardized questionnaire was administered to a systematic sample of the 1,906 nurses in Valcea District, Romania, to collect information on their knowledge, attitudes, and practices regarding injection administration and universal precautions.

Results:

Of the 180 nurses interviewed, 91% (95% confidence interval [CI95], 86% to 95%) reported having attended training for universal precautions; 58% (CI95, 49% to 67%) accurately reported that HBV remains infectious for at least 1 week in the environment; and 4% (CI95, 2% to 8%) knew that HBV is transmitted more efficiently than HrV through percutaneous exposures. No nurses reported reusing syringes or needles on different patients, but 4 (2%; CI95, 1% to 6%) would reuse a syringe and 3 (2%; CI95, 0% to 5%) would reuse a needle on the same patient in an emergency. Fifty-three percent (CI95, 44% to 61%) of nurses reported having a dedicated area for the preparation of injectable medications separate from where blood-contaminated items were handled. Shortages of infection control supplies were common.

Conclusions:

Although nurses in Valcea do not report reusing injection equipment without sterilization, other unsafe practices occur that may facilitate HBV transmission through injections, including preparing injectable medications in areas potentially contaminated with blood. Inadequate knowledge of blood-borne pathogen transmission and shortages of infection control supplies may contribute to these unsafe practices. Addressing these deficits could improve injection safety in Romania.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 1 , January 2004 , pp. 30 - 35
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Hersh, BS, Popovici, F, Jezek, Z, et al.Risk factors for HIV infection among abandoned Romanian children. AIDS 1993;7:1617–1624.CrossRefGoogle ScholarPubMed
2.Bohlen, C. Romania's AIDS babies: a legacy of neglect. New York Times. February 8, 1990:A1, A2.Google Scholar
3.Centers for Disease Control and Prevention. Frequency of vaccine-related and therapeutic injections: Romania, 1998. MMWR 1999;48:271–274.Google Scholar
4.Hutin, YJF, Craciun, D, Ion-Nedelcu, N, Mast, EE, Alter, MJ, Margolis, HS. Using surveillance data to monitor key aspects of the epidemiology of hepatitis B virus (HBV) infection in Romania. Presented at the 36th Annual Meeting of the Infectious Diseases Society of America; November 12-15, 1998; Denver, CO.Google Scholar
5.Scheaffer, RL, Mendenhall, W, Ott, L. Elementary Survey Sampling, ed. 4. Boston: PWS-Kent Publishing; 1990.Google Scholar
6.Beldescu, N, Apetrei, R, Calumfirescu, A. Nosocomial transmission of HIV in Romania. VI International Conference on AIDS; June 20-24, 1990; San Francisco, CA.Google Scholar
7.Sheth, NK, Post, GT, Wisniewski, TR, Uttech, BV. Multidose vials versus single-dose vials: a study in sterility and cost-effectiveness. J Clin Microbiol 1983;17:377–379.CrossRefGoogle Scholar
8.Kidd-Lunggren, K, Broman, E, Ekvall, H, Gustavson, O. Nosocomial transmission of hepatitis B virus infection through multiple-dose vials. J Hosp Infect 1999;43:57–61.Google Scholar
9.Webster, G, Hallet, R, Whalley, SA, et al.Molecular epidemiology of a large outbreak of hepatitis B linked to autohaemotherapy. Lancet 2000;356:379–384.CrossRefGoogle ScholarPubMed
10.Grob, PJ, Bischof, B, Naeff, F. Cluster of hepatitis B transmitted by a physician. Lancet 1981;2:1218–1220.Google Scholar
11.Ross, RS, Viazov, S, Gross, T, Hofmann, F, Seipp, HM, Roggendorf, M. Transmission of hepatitis C virus from a patient to an anesthesiology assistant to five patients. N Engl J Med 2000;343:1851–1854.Google Scholar
12.Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR 2001;50(RR-5):1–43.Google Scholar
13.Paquet, C, Babes, VT, Drucker, J, Senemaud, B, Dobrescu, A. Viral hepatitis in Bucharest. Bull World Health Organ 1993;71:781–786.Google ScholarPubMed
14.Woodruff, BA, Popovici, F, Beldescu, N, Shapiro, CN, Hersh, BS. Hepatitis B virus infection among pregnant women in northeastern Romania. Int J Epidemiol 1993;22:923–926.Google Scholar
15.Hagan, H, McGough, JP, Thiede, H, Weiss, NS, Hopkins, S, Alexander, ER. Syringe exchange and risk of infection with hepatitis B and C viruses. Am J Epidemiol 1999;149:203–213.CrossRefGoogle ScholarPubMed
16.Bialek, SR, Bower, W, Mottram, K, Miron, C, Williams, IT, Bell, BP. Outbreak of hepatitis B and D among injection drug users in Pierce County, WA. Presented at the 50th Annual Epidemie Intelligence Service (EIS) Conference; April 23-27, 2001; Atlanta, GA.Google Scholar
17.Hagan, H, Thiede, H, Weiss, NS, Hopkins, SG, Duchin, JS, Alexander, ER. Sharing of drug preparation equipment as a risk factor for hepatitis C. Am J Public Health 2001;91:42–46.Google ScholarPubMed
18.Gerberding, JL. Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and cytomegalovirus among health care personnel at risk for blood exposure: final report from a longitudinal study. J Infect Dis 1994;170:1410–1417.Google Scholar
19.Kozoil, DE, Henderson, DK. Risk analysis and occupational exposure to HIV and HBV. Curr Opin Infect Dis 1993;6:506–510.Google Scholar
20.Michalsen, A, Delclos, GL, Felknor, SA, et al.Compliance with universal precautions among physicians. J Occup Environ Med 1997;39:130–137.CrossRefGoogle ScholarPubMed
21.Mungherera, M, van der Straten, A, Hall, TL, et al.HIV/AIDS-related attitudes and practices of hospital-based health workers in Kampala, Uganda. AIDS 1997;11(suppl 1):S79–S85.Google Scholar
22.Centers for Disease Control and Prevention. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997;46(RR-18):1–42.Google Scholar
23.Mahoney, FJ, Stewart, K, Hu, H, Coleman, P, Alter, MJ. Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Arch Intern Med 1997;157:2601–2605.Google Scholar
24.Centers for Disease Control and Prevention. Hepatitis B virus: a com-prehensive strategy for eliminating transmission in the United States through universal childhood vaccination. MMWR 1991;40(RR-13):1–17.Google Scholar
25.Peter, G, ed. 1997 Red Book: Report of the Committee on Infectious Diseases, ed. 24. Elk Grove Village, IL: American Academy of Pediatrics; 1997.Google Scholar